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Heart failure (HF) is a highly prevalent disease associated to a worse prognosis and characterized by a strong neurohormonal activation playing a significant role in myocardial and multi-organ adaptations to the failing cjc 1295
[12]. Neurohormones and biomarkers testing may contribute to the risk stratification and treatment selection of patients with HF.

Abnormalities of phosphorus homeostasis have been linked to cardiovascular risk in different populations. A greater risk of HF has been associated to increased serum phosphorus in a community-based study [2]. Several other studies have also linked phosphorus levels to cardiac hypertrophy and mortality in patients with chronic kidney disease (CKD) and in patients with coronary artery disease (CAD) [11] and [21].

Fibroblast growth factor 23 (FGF23), a bone-derived protein, is an important regulator of the phosphorus homeostasis [15]. The amino-terminal portion of FGF23 (amino acids 1–24) may serve as a signal peptide allowing the secretion into the blood circulation and the carboxyl-terminal portion (aa 180–251) participates to its biological action. FGF23 levels are independently associated with left ventricular mass index and hypertrophy as well as mortality is patients with CKD [5], [10] and [20]. Seiler et al. showed that FGF23 was associated with left ventricular dysfunction and atrial fibrillation in CAD subjects even in the absence of impaired renal function [19]. FGF23 levels have been studied in patients with stable CAD and were also independently associated with mortality and cardiovascular (CV) events [13]. More recently, Plischke et al. have reported an independent prognostic value of intact FGF23 for all-cause mortality in stable systolic HF [14].

The aim of our study was to determine the circulating levels of C-terminal FGF23 (Ct-FGF23) in heart failure patients with reduced left ventricular ejection fraction (HF-REF) and their predictive value of long term CV death. The relation of Ct-FGF23 with estimated glomerular filtration rate (eGFR), calcium, phosphorus, parathyroid hormone (PTH) and B-type natriuretic peptide (BNP) levels was also evaluated.

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